Area Editoriale
Pellisé M, López-Cerón M, Rodríguez de Miguel C, Jimeno M, Zabalza M, Ricart E, Aceituno M, Fernández-Esparrach G, Ginès A, Sendino O, Cuatrecasas M, Llach J, Panés J.
Dopo due studi di confronto con la colonscopia convenzionale, che non avevano dimostrato alcun vantaggio dell'NBI (Vedi citazioni in PubMed) , questo studio randomizzato cross-over sembrerebbe dimostrare che l'NBI è leggermente ma significativamente meno efficiente della cromoendoscopia, anche se consente di identificare alcune lesioni sfuggite alla prima e di concludere l'endoscopia in tempi più rapidi
Un editoriale sottlinea i limiti dello studio ed il fatto che questi dati non ci consentono ancora di delineare con sicurezza l'eventuale ruolo dell'NBI nella sorveglianza delle IBD di lunga data
Pellisé M, López-Cerón M, Rodríguez de Miguel C, Jimeno M, Zabalza M, Ricart E, Aceituno M, Fernández-Esparrach G, Ginès A, Sendino O, Cuatrecasas M, Llach J, Panés J. Narrow-band imaging as an alternative to chromoendoscopy for the detection of dysplasia in long-standing inflammatory bowel disease: a prospective, randomized, crossover study. Gastrointest Endosc. 2011;74:840-8
BACKGROUND: Narrow-band imaging (NBI) is a novel technique that may represent an alternative method to chromoendoscopy (CE) for the detection of colitis-associated intraepithelial neoplasia (IN) in patients with long-standing inflammatory bowel disease (IBD). OBJECTIVE: To compare NBI with CE for the detection of IN. DESIGN: Prospective, randomized, crossover study. SETTING: Academic hospital. PATIENTS: Patients with clinically inactive colonic IBD (≥8 years). INTERVENTION: Patients underwent both CE and NBI in randomized order. Targeted biopsy specimens from abnormal areas were obtained. Pathological examination was regarded as the reference standard. MAIN OUTCOME MEASUREMENTS: Number of false-positive and true-positive lesions in patients undergoing CE and NBI were compared as well as the proportion of patients with missed IN lesions. RESULTS: Eighty patients were screened, of whom 20 were excluded. Mean ± standard deviation withdrawal time for CE was significantly longer than that for NBI (26.87 ± 9.89 minutes vs 15.74 ± 5.62 minutes, P < .01). Thirteen patients had at least 1 IN lesion on 1 of the examinations. In the per-lesion analysis, NBI resulted in a significantly inferior false-positive biopsy rate (P = .001) and a similar true-positive rate. The percentage of missed IN lesions and patients was superior with NBI, albeit without reaching statistical significance. LIMITATIONS: Lesions were sampled immediately after detection, which precluded the possibility of paired analysis. CONCLUSIONS: NBI appears to be a less time-consuming and equally effective alternative to CE for the detection of IN. However, given the NBI lesion and patient miss rates, it cannot be recommended as the standard technique Bernstein CN. The color of the most effective tool to use in dysplasia surveillance in inflammatory bowel disease. Gastrointest Endosc. 2011t;74:849-51.